Phaco Smash: My Surgical Technique and Great News
This week I received great news: my surgical technique of Phaco Smash had the lowest CDE (Cumulative Dissipated Energy) numbers of all the surgeons in our surgi-center on both the LenSx femtosecond laser and the Catalys femtosecond laser. This is great news indeed.
The term CDE is not discussed often with patients, but the total Cumulative Dissipated Energy used in a patient’s eye surgery represents how much Phacoemulsification ultrasound energy was needed to remove a cataract.
Phacoemulsification refers to modern cataract surgery in which the eye’s internal lens is emulsified with an ultrasonic handpiece and machine and aspirated from the eye. Aspirated fluids are replaced with irrigation of balanced salt solution, thus maintaining the anterior chamber, as well as cooling the handpiece.
Ultrasound energy affects the inner lining of the corneal called the corneal endothelial cells. Too much ultrasound energy can damage these cells permanently and lead to a prolonged surgical recovery time, short term and long term blurred vision, and in some cases a loss of vision requiring a corneal transplant. Additionally too much ultrasound energy appears to increase the risk of fluid leaking under the macula and causing CME: Cystoid Macular Edema which can lead to temporary loss of best corrected vision and in rare cases permanent loss of best corrected vision.
New femtosecond laser technology, such as the Catalys and LenSx machines, break up the cataract inside the eye using femtosecond laser technology so we can use less phacoemulsification ultrasound energy and thus save the important cells and cell barriers inside the eye.
Phaco Smash is a technique I developed while at Harvard. I taught the residents this technique but did not have time to write it up or even publish my CDE scores while there. I did present a paper or Risk Stratification at the AAO in order to be able to analyze CDE scores and such surgical parameters.
One of my colleagues started using this technique and immediately noted a decrease in CDE scores.
Now we will need to see if this translates in to better post operative day 1 vision and long term healthier corneal endothelial cells.
Coming soon:
I will post a link to my surgical video to Phaco Smash and hopefully submit a paper soon about the CDE scores.